Delhi’s air pollution has once again reached hazardous levels, and it is the city’s children who are paying the heaviest price. As a physician, I see this not just as an environmental crisis, but as a profound public health emergency that is damaging the lungs, immunity, and long‑term development of an entire generation. The recurring winter smog is no longer a seasonal nuisance; it is a chronic assault on the most vulnerable among us.
A Surge in Pediatric Respiratory Illness
Across Delhi and the National Capital Region, pediatric clinics are overwhelmed. In the past few weeks, I have spoken with colleagues in Noida and other parts of the capital who report a tenfold increase in children presenting with coughing, wheezing, and breathing difficulties. Many of these cases are severe: pneumonia, bronchiolitis, and acute exacerbations of asthma that require oxygen and steroid nebulization.
Parents describe nights of terror—children waking up gasping, vomiting from violent coughing, and becoming listless and unresponsive. One mother told me that when her one‑year‑old daughter stopped reacting during a night coughing fit, she feared she was losing her. That child was later diagnosed with pneumonia and spent days on oxygen support. Even after recovery, the parents live in constant anxiety; now, any cough triggers panic.
Why Children Are Hit Hardest
Children are uniquely vulnerable to air pollution for several biological reasons:
- Their lungs are still developing, and exposure to fine particulate matter (PM2.5) can impair lung growth and reduce lung capacity for life.
- Their immune systems are immature; chronic exposure to pollutants weakens defenses, making them more susceptible to infections.
- They breathe faster than adults, so they inhale more pollutants per kilogram of body weight.
- They spend more time outdoors and closer to the ground, where some pollutants concentrate.
The World Health Organization’s safe limit for PM2.5 is 5 µg/m³ annual average. In Delhi, levels have hovered between 300–400 on the Air Quality Index (AQI), which is more than 20 times higher than the recommended limit. At these levels, even healthy adults are at risk, but children and the elderly suffer the most severe consequences.
The Long‑Term Health Toll
This is not just about acute illness; it is about lifelong damage. Studies show that early, repeated exposure to severe air pollution is linked to:
- Stunted lung development and reduced lung function in adulthood.
- Higher rates of chronic obstructive airway disease, similar to what is seen in long‑term smokers.
- Weakened immunity and increased susceptibility to respiratory and other infections.
- Lower cognitive performance and potential impacts on learning and school performance.
Emerging evidence also suggests a higher risk of dementia and neurodegenerative diseases later in life, including Alzheimer’s, due to long‑term exposure to outdoor air pollution. In practical terms, this means that children growing up in Delhi today may face a lifetime of respiratory problems, reduced physical capacity, and increased healthcare needs—simply because they were born in a city with unbreathable air.
The Limits of Short‑Term Measures
Each winter, the government responds with emergency measures: halting construction, restricting vehicles, and even attempting cloud seeding to induce artificial rain. These actions, while well‑intentioned, have failed to meaningfully reduce pollution or protect children.
For families with resources, the response is to keep children indoors, switch to hybrid schooling, and use N95 masks when outdoors. But for hundreds of thousands of children in low‑income households—those living in cramped homes near busy roads, in informal settlements, or exposed to indoor pollution from cooking fuels—the assault on their lungs is relentless. These children have no real escape from the toxic air.
What Parents and Policymakers Must Do
As a physician, I urge both families and authorities to act with urgency.
For parents and caregivers:
- Minimize outdoor activity on days when the AQI is in the “very poor” or “severe” range.
- Keep children indoors as much as possible, especially during early morning and evening hours when pollution peaks.
- Ensure good indoor ventilation and use air purifiers where feasible.
- Keep children well‑hydrated and maintain a nutritious diet to support immunity.
- Use properly fitted N95 masks when children must go outside, as these filter out about 95% of fine particulate matter.
For policymakers and health authorities:
- Treat severe air pollution as a public health emergency, not just an environmental issue.
- Invest in long‑term solutions: stricter emissions standards, cleaner public transport, and a shift away from fossil fuels.
- Expand access to clean cooking fuels and improved housing for low‑income families.
- Strengthen pediatric surveillance and early intervention programs for respiratory diseases.
- Support research into the long‑term health impacts of pollution on children and integrate these findings into urban planning and health policy.
A Generation at Risk
The question many parents now ask is not just “How do we survive this winter?” but “What kind of future are we giving our children?” One mother put it simply: “What is the point of living in a city where my daughter can’t even breathe safely?” For now, many feel trapped by work and family obligations, but the desire to leave Delhi is growing.
Delhi’s pollution crisis is not inevitable. With sustained political will, scientific guidance, and community action, it can be reversed. But until then, we must recognize that every child gasping for air in a Delhi clinic is a stark reminder: when a city chokes, its children suffer first, and they suffer most.
— Dr. George Shamma, MD
Consultant Physician & Public Health Advocate
